The German medical cannabis market is one of the largest in the world. Indeed, as of 2021, it is not only the largest market in Europe, but also responsible for driving cultivation plans across many sunnier and lower labor cost locales. This is true of both countries in the European Union (EU) and further flung spots, all hoping to export cannabis to a country, which so far has not, by design, been able to domestically source the medical cannabis consumed in the country. 

All well and good—but this is the good news. 

In fact, the pharmaceutical infrastructure that faces medical cannabis companies is far from either clear cut or easy to navigate. Here is why.

Cannabis is Defined by Law as a Controlled Narcotic Drug

The first issue facing all distributors in the German market, is that cannabis, legally, is defined as a narcotic at a federal level. To date, despite a decision on the European level last fall, this also includes low THC hemp—which has led to a number of lawsuits and embarrassing contretemps of late even on the non-medical, commercial level. 

Beyond this, however, cannabis as medicine is clearly now present in the system—but merely importing and or registering strains and brands (no matter who makes them or where such flower or products come from) is far from enough to get sales.

Unlike the U.S. (for example), pharmaceutical drugs may not be advertised directly to potential consumers (also known as patients).

As a result, cannabis specialty, just like general pharmaceutical distributors, must engage in a strange, highly inefficient and expensive, three-step process to obtain prescriptions that starts but does not, by any means end, with what is euphemistically called “doctor education.”

Step by Painful Step

The first pre-step is actually still quite difficult for all nascent distributors who are not in business at all and wish to jump directly into the cannabis specialty business. Namely, before they can obtain their final licensing and approvals, they must identify a qualified supplier. As there is only one distributor in the country that handles domestically grown cannabis, this means that everyone else has to find companies who want to work with them. 

Five years ago, this meant one of two things. Find a Canadian company who wanted to expand to Europe and Germany or go to Bedrocan, the Dutch cultivator right across the border. As a result of the early rush, Bedrocan also began to limit both the amount of cannabis it was willing to sell, per distributors this way, and then limited the number of distributors it was willing to work with.

The Difficulties and Dichotomies of German Cannabis Prescriptions

Once a distributor has at least one offtake agreement with a certified company and all its licensing and approvals in place, the real struggle begins. To get your strain or brand of cannabis sold in German pharmacies, distributors must do several (expensive and time consuming) things beyond just obtaining the licenses required and obtaining the product. They must educate doctors about their strain or product and find patients to advocate for their brand when they do get in front of a cannabis prescribing doctor. 

For the privately insured, finding a doctor is not a big issue anymore, particularly in the larger cities. “Schmerz zentrums” (pain clinics) are staffed by doctors who are usually sympathetic to patients with a provable, pre-diagnosed condition. If one has private insurance, it is also not necessary to get a referral by a general practitioner. That said, both the doctor visit and the cannabis must be paid for, out of pocket and up front, by the patient. 

For those on statutory or “public” health insurance, the battle is even tougher, starting with finding willing doctors. Once found, however, it is at this point that the doctor must work with the patient to fill out forms and wait for the approval from the regional approvers (not even individual health insurers). Once that approval happens, patients can then ask for the brand of cannabis they want. Assuming the doctor is sympathetic and does so, they must then take this prescription, with the specific brand written on the paper itself, to a specialist pharmacy. These days, such pharmacies can order overnight.

Regardless, none of this is easy. So far, distributors have relied on a variety of methods (including free press, hiring pharma representatives and sponsoring events) to try to reach both the public and prescribing doctors. To add even more complications, the availability of doctors and their willingness to prescribe also varies by state.

For example, the Frankfurt city agency responsible for training new cannabis doctors will not give out the names of doctors they have trained. Further, as admitted to High Times, they understand that most doctors who work with statutory health insurance patients in the state of Hesse are refusing to take on more than two cannabis patients per practice.

The Future of Generic Extracts

Given all of these problems, not to mention the markup that is available, liquid dronabinol, the global generic, 96 percent THC extract, is highly popular in the German market these days. The reason? It is easier to market to both doctors and patients, not to mention obtain approval via health insurance (because of the “generic” designation).

That said, most patients do not want to take this extract, preferring other medications or treatments.

Patient Outreach Remains Critical but Hard

Every distributor in Germany maintains online patient outreach. Indeed, Facebook and other social media groups for patients are relatively widespread. However, this is far from a panacea. As dedicated as patients can be to specific brands, they are most dedicated to finding a regular supply and source of their drug.

This remains, by far, the hardest hurdle to broach, sadly, in a country with insurance coverage of cannabis at least by statute, but where it also took until late last year for the first patient to secure a guaranteed yearlong prescription.

Until any of these dynamics change—via legal challenge or greater statutory reform—marketing any kind of cannabis, and via any source, traditional or not, is an uphill challenge.

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